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Commonwealth Fund International Health News Brief: 2018, No. 4

International Health News Brief Australia

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Website Launched for End-of-Life Care Planning in Australia

Country Correspondent: Aisha Gomez

In April Australia launched the new End of Life Directions for Aged Care (ELDAC) website to help health professionals access information and resources on palliative care and advanced care planning. It features five toolkits, on topics such as residential aged care, home care, and legal matters. Each contains fact sheets, guides, podcasts, and patient resources. The site also includes a navigation tool to help access local resources, as well as a national free advice phone line. The website was developed by the ELDAC expert consortium, with members from Australia’s Healthcare and Hospitals Association, three universities, and provider and patient groups. The consortium is part of the Australian government’s three-year commitment to improve advance care planning for older adults.

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Canada

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Ontario Announces Expansion of Free Prescription Drugs to Seniors

Country Correspondent: Aisha Gomez

Just months after Ontario launched its free prescription drug program for children and adults under 25, Ontario Premier Kathleen Wynne announced that the Ontario Health Insurance Plan (OHIP+) prescription drug plan will be expanded to seniors 65 and older, the province’s fastest-growing age group. Starting in August 2019, seniors will be able to collect more than 4,400 medications free of charge by presenting a prescription and their OHIP+ number at any pharmacy. Currently, older adults pay an average of CAD 240 out of pocket each year under the current drug benefit program in deductibles and copayments. The province is investing CAD 575 million to expand the OHIP+ to seniors by 2020–21.

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Ontario Invests $1 Billion to Support Seniors and Caregivers

Country Correspondent: Aisha Gomez

Ontario is investing CAD 1 billion over three years to support the Seniors' Healthy Home Program. Starting in 2019, the program will provide up to CAD 750 per year to eligible households led by seniors 75 and older to support caregivers and help elders live independently longer. The initiative runs parallel to other investments in the 2018–19 budget to support elders, including CAD 650 million for improving home and community services, establishing the Ontario Caregiver Organization, and making investments in new long-term care homes.

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France

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French Bank and National Health Insurance Fund Support Start-Ups Investing in Health IT

Country Correspondent: Paul Dourgnon

Last year, the French public investment bank Bpifrance launched a EUR 50 million “patient autonomy fund” (Fond Patient Autonome) to invest in start-ups devoted to health information technology. Bpifrance is now developing a structured partnership with the National Health Insurance Fund to better target projects to enhance patient autonomy with digital health technologies. The Fund will support all project phases, from inception to marketing assessment to national and international development.

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New Mental Health Care Pilots Launched in France

Country Correspondent: Paul Dourgnon

The National Health Insurance Fund is conducting local pilot projects for patients suffering from moderately severe mental health disorders. The program aims to curb the widespread use of antidepressants by allowing free access to psychologists after a primary care referral. Many experts consider mental health research to be underfunded in France. Although spending on mental health disorders exceeds spending on cancer (EUR 19 billion vs. EUR 14 billion), research spending on mental health represents only 4 percent of public health research expenditures — four times less than is spent cancer research. Each year, 7 million patients are treated for mental health disorders in the French health care system.

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Germany

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Efforts Continue to Implement Digital Health Insurance Card in Germany, Despite Delays

Country Correspondent: Michael Laxy

Fourteen years ago, the German ministry of health began to plan for a digital health insurance card for all patients. The card is intended to serve as a safe way for patients to share their electronic health records with providers and help coordinate information-sharing among physicians, hospitals, and other providers. Despite spending EUR 1 billion over the past 14 years, with little progress in implementing the card, the ministry of health has confirmed in a recent press statement that efforts will be continued. Various logistical and political difficulties have delayed implementation despite the sizeable investment.

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Netherlands

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Dutch Insurer Launches Quality-Based Payment Contracts for Cardiac Disease

Country Correspondent: Margje H. Haverkamp

Menzis, one of the largest Dutch health insurers, has started paying hospitals for stents and bypass surgery, based on the quality of the care delivered. Menzis has signed three-year contracts with 10 Dutch hospitals. They will be paid a fixed bundle per patient and subsequently carry risk and benefits depending on the treatment outcomes, based on data from the National Heart Registry. Menzis expects to extend this payment model to rheumatoid arthritis, breast cancer, and kidney failure over the next year.

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Dutch Government to Start Reviewing Cost Component of Quality Guidelines

Country Correspondent: Margje H. Haverkamp

Until now, medical experts and the Dutch Care Institute have made decisions regarding national quality guidelines independent of the Dutch government. Health care ministers Bruins and de Jonge have added a new review step to analyze costs, and possibly vet content according to financial sustainability requirements, before standards can be made public. The move comes after expert calls for the government to take the lead in containing rising health care costs, rather than relying on insurers and providers to agree on allowable health care costs increases (known as “zorg-accoorden”).

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New Zealand

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Partnership to Provide Maori Free Health Insurance

Country Correspondent: Aisha Gomez

A deal between the Ngati Whatua Orakei trust and the Australian insurance company Nib will offer free private health insurance to 4,000 members of the Ngati Whatua Maori subtribe across the country. The insurance will cover surgical and medical hospitalization and options for specialist consultations, as well as help with day-to-day health costs for primary care, dental services, physiotherapy, and vision costs. New Zealand’s public health care system already offers free emergency and hospital health care, as well as low-cost primary care coverage. Nevertheless, Maori people experience greater unmet health needs than nonindigenous New Zealanders. Depending on the success of the collaboration, this public–private alliance may become a model to improve the health care of tribal groups.

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Norway

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New Five-Year National Cancer Strategy Launched in Norway

Country Correspondent: Marianne Storm

In April 2018, Health Minister Bent Høie presented the Norwegian cancer strategy for 2018-22. The strategy focuses on improving quality of life for cancer patients, survivors, and their families; improving coordination between specialist and primary care; boosting implementation of measures to prevent cancer; and increasing treatment capacity. One key goal is to implement clinical pathways for cancer patients to ensure safe transition from specialist to primary care.

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Safer Use of Chronic Disease Medications Through Medicine Start Program

Country Correspondent: Marianne Storm

As part of the government's budget for 2018, Norwegian parliament (Storting) introduced the Medicine Start program to ensure the safe use of drugs for patients with chronic diseases. The program offers cardiovascular patients consultations with local pharmacists regarding their treatment with antihypertensive, cholesterol-lowering, or blood-thinning medications. The aim is to instruct patients in taking drugs safely — in the right amount, at the right time, and according to doctors’ recommendations. Pharmacies will be reimbursed NOK 225 (approximately USD 28) per patient consultation, and all patients will be eligible to receive two consultations.

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Sweden

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Swedish Report Shows More Elders Taking Multiple Drugs

Country Correspondent: Roosa Tikkanen

An annual national report on the quality of care for older adults found that the share of elders who receive multiple medications had increased from the previous year. The March 2018 report, which covers 28 care coordination indicators, found that in 2017 nearly one of three nursing home patients (32%) age 75 and older were receiving 10 or more prescription drugs, compared to one of four in 2016 (26%). However, the use of drugs deemed unsafe for elderly patients had decreased. Further, the share of patients age 65 and older with hip fractures had decreased, and the share of elders who have had end-of-life discussions with a health care professional had increased, compared to 2016.

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During “Senior Week,” 144,000 Elderly Swedish Adults Received Free Medication Review

Country Correspondent: Roosa Tikkanen

The Swedish Pharmaceutical Association's annual "Senior Week" (Seniorveckan) in April aimed to raise awareness of safe medication use among elderly patients taking multiple medications. This year, Electronic Expert Support (EES) checks were offered free to all patients age 75 and older, with more than 144,000 patients at 1,400 pharmacies across the country receiving them. The EES uses information from the electronic patient record to check for drug interactions, unsafe drugs, and dosage mistakes. It is offered at all community pharmacies across Sweden. The use of EES checks increased from 950,000 in 2016 to 2.5 million in 2017.

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Patient Fees Clarified for Online Doctor Consultations in Sweden

Country Correspondent: Roosa Tikkanen

The Swedish Association of Local Authorities and Regions (SKL) has recommended a minimum patient fee of SEK 100 (USD 12) for digital doctor visits. Individual counties can decide to charge prices above this level. Last year, SKL halved provider reimbursement of digital consultations from SEK 1,250 to SEK 650. The decision was made in response to dramatic increases in the number of digital visits and because the majority were for low-acuity concerns. In a press release, SKL maintained that the new, lower reimbursement will disincentivize unnecessary visits, but will still support the growth of digital services.

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Switzerland

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Annual Drug Review in Switzerland to Save Millions Annually

Country Correspondent: Lars Hemkens

In 2017, the Swiss Federal Office of Public Health (FOPH) reduced prices for more than 400 prescription drugs, resulting in savings of approximately CHF 190 million in 2017 alone. The average price reduction per drug was approximately 18 percent. FOPH conducts a review of all drugs covered under the statutory health insurance system every three years. The review is based on cross-country comparisons and comparisons with other drugs.

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United Kingdom

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NHS Boosts Role of Pharmacists in Reducing Overmedication and Improving Asthma and Dementia Care

Country Correspondent: Molly Fitzgerald

England's National Health Service (NHS) plans to recruit an additional 240 pharmacists and pharmacy technicians in nursing and residential care homes in an effort to curb overmedication and hospital stays among elderly patients. Approximately 180,000 care home residents are expected to receive reviews of their current medication lists to identify potentially harmful interactions and duplicative medications. In addition, more than 90 percent of England’s community pharmacies have taken part in NHS England’s Quality Payments Scheme, which incentivizes pharmacies to provide clinical services in the community. Since April 2017, the scheme has referred more than 12,500 high-risk asthma patients for a full review, and trained 70,000 pharmacists as “dementia friends” for elderly patients.

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Clinician-Led Price Matching and Bulk Buying Create Savings for Commonly Used Hospital Products

Country Correspondent: Molly Fitzgerald

Clinicians at seven hospitals in Sheffield joined together to create a unique "price-match" scheme that jointly evaluated commonplace items, such as surgical gloves and antiembolism socks, on quality and cost. The hospitals teamed up to buy 11 items in bulk, resulting in savings of GBP 2 million. The savings will be reinvested in better frontline patient care. Prior to the scheme, each hospital department had procured its own products in smaller quantities across a variety of brands, paying different prices for the same product.

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Personalized Health Budgets to Become Available to 350,000 More NHS Patients

Country Correspondent: Molly Fitzgerald

Jeremy Hunt, former Health Secretary, and Simon Stevens, Chief Executive of NHS England, have backed a government proposal that would give around 350,000 additional people with mental health conditions and physical disabilities access to personalized health and social budgets. Personalized NHS budgets allow patients or their guardians to determine how to allocate funds — potentially tens of thousands of pounds per person — between health care and social care services. Services could include home care for patients or respite care for family caregivers. Currently, 23,000 people in England already have personalized NHS budgets.

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New NHS General Practitioner Contract to Improve Access to After-Hours Care and Digital Tools

Country Correspondent: Molly Fitzgerald

A new general practitioner contract took effect April 1, 2018, with a 3.4 percent increase in investments to improve access to care. This will help complete the national rollout of the Electronic Prescription Service and e-Referral Service, which will help GPs and patients identify hospitals with the shortest wait times. In addition, local GP practices are working together to make evening and weekend appointments available in all areas of the country starting in October. The contract also specified that GP practices are not permitted to advertise private services that should be provided free within the National Health Service (NHS). Simon Stevens, Chief Executive of NHS England, said that the contract is “a concrete step in strengthening general practice, which is at the heart of our modern NHS.”

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Commonwealth Fund International Health News Brief: 2018, No. 4